If you have a group health plan, you can enroll in Medicare when you qualify at age 65 (or under the age of 65 due to a long term illness or disability). But, when should you delay Medicare, and how do you avoid a penalty?
If you have retiree group coverage (Federal, State, or Union) through your employer or your spouse’s employer, you will have to check with the plan administrator, union rep, or H/R department to find out what the plan rules say or contract dictates. Each contract (contract negotiation) is different and benefits can and will be different that are being offered to retirees. The plan administrator will let you know if Medicare is primary.
Note: Medicare is usually primary in this situation.
If you are still working (active employment) and have health coverage through your employer or your spouse’s employer, you will
most likely be able to delay Medicare Parts A, B, and/or D without getting penalized, although you do need to be careful!!
There are other factors you need to know and you could be at risk and end up owing lifetime late enrollment penalties. Here are some of the rules:
👉 If the company you or your spouse works for has
under 20 employees, Medicare is primary coverage. So, you would need to apply for Medicare Part A and B.
👉 If the company you or your spouse works for has 20 or more employees, group health insurance is primary coverage. So, you would not need to apply for Medicare Part A or B.
In this situation, you can apply for Part A (with group health insurance as primary coverage/ Medicare Part A (hospital) would be secondary coverage) and decline Part B (doctor/medical coverage).
BUT, If you have enrolled in Social Security (income) benefits and are eligible for Medicare (health insurance), at age 65 or older, then you should apply for Part A (hospital coverage) and can decline Part B until you are no longer working and need to sign up and add Part B benefits.
👉 If you get qualifying coverage through your domestic partner’s workplace, but aren’t married to him or her, and delay your Medicare coverage .... you could be faced with a lifetime late enrollment penalty.
👉 If your employer does not offer creditable prescription drug coverage (meaning coverage equivalent to Medicare) and you go at least 63 days without creditable drug coverage, you could be faced with a lifetime late enrollment penalty (when you finally enroll in a Medicare prescription drug plan in the future).
There are more factors to these rules. Please call with questions.